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John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In a Buy vs. Build decision, the key drivers are control and cost. Do you have control over your system at a cost you can afford? The decision calculus then shifts to ownership on two levels: First, can we have true ownership of our solution and make it work ourselves? Second, is the total cost of ownership economically sustainable?

Dr. Billings then goes on to make the case that open source EHR is the best of both worlds. He compares the open source EHR vista to Linux and Red Hat to Medsphere. It’s a pretty app comparison of what Medsphere is trying to do. Dr. Billings does point out that an enterprise EHR is not an operating system (like RedHat/Linux). Although, I find that ironic since I’ve written before about how I think that the EHR is the operating system of healthcare.

One major difference between Linux and VistA is how they’re implemented. Linux could be implemented by an organization on just a server or two while still running all the old servers on something else. Then, over time they could add in more Linux servers. This isn’t the case with VistA. Everyone wants an Enterprise EHR to be implemented across the entire system. I don’t see someone implementing VistA in one department and then growing from there. Maybe we should do it this way, but that’s not what I see happening in the market. They buy an EHR system they can use across their whole organization.

This difference aside, open source does provide an interesting balance between the buy vs build mentality. I wonder why hospital organizations have chosen other EHR vendors over the open source EHR alternatives.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The week after I got my first job implementing EHR, I went into the medical records office where I was shown an article about the government’s decision to open source the Vista EHR software. The HIM manager was drawn by the idea of a free EHR. Of course, the clinic I was working for had already invested hundreds of thousands of dollars on an EHR system. In fact, this is likely what made the HIM manager so interested in the idea of a free EHR. She didn’t know why we’d spent hundreds of thousands of dollars when the government was offering an EHR for free.

What she didn’t understand was that just because the software is free doesn’t mean that the EHR is free. Plus, she (and I at the time) had little understanding of what the Vista EHR software really encompasses. Implementing Vista in that small clinic would have been like taking a sledgehammer to a 2 penny nail. In fact, that might even be underestimating the breadth of what could be done with Vista.

Of course, if we had been in the hospital environment, then we should have definitely considered Vista. However, back then there were a lot of unknowns with how Vista would transition to open source and how it would work in a commercial healthcare environment. 8+ years later, the companies working with the open source EHR is much more mature.

One of the leaders when it comes to implementing Vista in hospitals is a company called Medsphere. Medsphere’s version of Vista is called OpenVista. What’s amazing is the stark contrast in costs between an open source EHR versus many of the proprietary alternatives. No doubt Medsphere and others are benefiting from the billions of dollars the VA spent developing Vista.

For those of you not familiar with Medsphere and OpenVista, check out this whitepaper summary of OpenVista. It’s a really great summary of the capabilities of the software and what Medsphere has done to improve on the Vista software.

I’m sure there are still many hospital CIOs that aren’t brave enough to choose an open source EHR when “know one gets fired for buying Epic.” Although, I think it’s a big mistake when hospital CIOs don’t even consider the open source EHR options. When you see the breadth and depth of what’s available in Vista, it’s definitely worth considering.

Plus, since it’s open source, you can still develop custom additions to the software without worrying whether your EHR vendor will let you create a deep connection to the EHR software. I see an open source EHR software as a great option for those hospitals that are use to developing custom applications in house, but also see how a commercial vendor has expertise that they don’t have in house.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Here’s a story out of the pages of Forbes which should make open source advocates happy. In it, we hear the tale of a northern California hospital which decided to buck corporate trends and go with VistA rather than pay for a big-ticket EMR from a vendor giant.

Three years ago, at the outset of its EMR search, Oroville Hospital was going down the same path as most of peers. But the CEO wasn’t terribly happy with that path. While the 153-bed hospital had shortlisted giants like Cerner, McKesson and Meditech as possible candidates, chief executive Robert Wentz was worried about the sky-high cost, disruption and — as a smaller facility — lack of clout with vendors, Forbes reports.

Shunning conventional choices, Wentz decided to take a risk on VistA. Not only did he go with the less-conservative choice, he decided not to partner with companies like Medsphere that help hospitals integrate and develop VistA to meet their needs. Instead, he chose to work with independent VistA experts (a rogue crew with day jobs of their own) rather than be tied to a particular vendor.

To coordinate the project, Wentz worked with the non-profit WorldVistA and Vista Expertise Network, both of which embrace hundreds of programmers with VistA smarts. Wentz worked with programmers from the two groups, not only to build out the hospital’s EMR but also to develop additional add-ons such as an e-prescribing package. WorldVistA CIO helped Oroville get its package certified for Meaningful Use, which brought in $5 million.

Now, three years into the project, Oroville has spent about $10 million on its EMR, about one-half of what it expected to spend on the giant EMR-makers’ software.

Now, it’s worth bearing in mind that Wentz and his IT team had to be more flexible than they would have if an army of consultants from Cerner or Epic had run the show. (I love the part in the Forbes story where a programmer told Wentz he had to end the call so he could make a trip to Costco. Classic.) But Oroville seems to have reaped the benefits. I wonder if this story will lead to more VistA adoption…

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

For my part, being the naughty contrarian that I am, I thought It’d turn John’s blog post on its head and answer the question “What Won’t Come Together In Health IT Over the Next 12 Months?” Here’s some of my predictions:

* EMR-to-EMR interoperability: Folks, from what I see we’re definitely more than a year from having a workable form of interoperability between systems or even routine high-volume data sharing. Really, do I even have to debate this one?

* High penetration by HIEs: With funding mechanisms and goals ranging all over the map — and players including health plans, broadband network providers like Verizon, hospital coalitions and more — I just can’t see the HIE picking up a lot more market share over the next 12 months. Too many organizations involved, and too much to figure out.

* Major uptick in open-source HIT use: Time and again, I’m reminded that far too many hospital leaders, government CIOs and medical practice leaders aren’t ready to take open-source tools seriously despite the myriad of good reasons to do so. I don’t think this is poised to change in the near term, sadly.

* Epic controls the hospital EMR world for good: Yes, hospitals are still switching over to Epic. And yes, hospital cutovers to Epic probably haven’t even hit their all-time peak. But the smaller to medium-sized hospitals that just can’t afford Epic are still in play, and there’s a lot of them. Let’s see who comes riding in to put the lock on this niche before we crown Epic world heavyweight champ.

* Major growth in remote monitoring: Mobile technologies are becoming more critical daily to the practice of medicine. But somehow, that doesn’t translate to a hunger for home-monitoring patients using, say, wireless glucose monitors. I’ve been watching this sector for years and it still seems like it could explode, but I’m not seeing critical mass this year.

Having been Scrooge for a bit, I certainly have to join John in saying that yes, this is likely to be a pivotal year for the EMR industry, and for #HIT entrepreneurs. I just think we’re going to remain stuck with some of these legacy issues for some time to come.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Most of the hospitals I write about go with big, expensive commercial EMR packages and suffer through upgrades and code fix schedules imposed by the vendor. The process seems pretty miserable, and rather inefficient, but IT departments are stuck with it.

Oklahoma-based Stilwell Memorial Hospital, a 50-bed public facility, has decided to install Medsphere Systems Corp.’s OpenVista EHR. The Medsphere product is an open source derivative of the Department of Defense’s widely praised VistA system. Rather than millions of upfront bucks, Medsphere charges a subscription fee for OpenVista use.

As part of choosing OpenVista, Stilwell Memorial becomes part of Medsphere’s “Healthcare Open Source Ecosystem,” in which various users share code, system upgrades and tips for managing the system.

The question that pops into my head, as I read the background on this install, is why we’re hearing about a 50-bed hospital making this selection, but few if any medium-sized or large community hospitals.

After all, given its history as a massive DoD implementation, I don’t think there’s any question that VistA scales up well. And we are all over the taint open source once had as too casual a community for hard-core enterprise use, right? By at least a decade?

The truth, however, is that we probably all know the answer. The reason open source EMR installations are still in the minority is that CEOs and board members like the sound of having a giant, sprawling corporate partner better than working with a community. Meditech, Epic, Cerner and Siemens are more or less automatically shortlisted.

Sigh. Wouldn’t it be nice if hospital C-suite folks and boards were more flexible? Great things could happen.

I often hear that when it comes to becoming Epic certified, for the most part getting the golden ticket boils down to a matter of luck. Being at the right hospital at the right time can do wonders for a career in heath IT, but some sitting on the sidelines continue to wonder why it’s so hard to break in when there’s so much demand. In the midst of a huge project to “light-up” broad swaths of our national inpatient healthcare system, why would anyone dominating an industry make it almost impossible to gain the skills necessary to manage their system without being employed by one of their customers?

It’s recognized that proprietary elements and event whole systems are used to gain a competitive advantage in many software systems. However, when the deal is won and it’s time to move on the the next project, shouldn’t it be incumbent upon a vendor to do their best to make their project successful in the least amount of time, and in the most cost effective way? Why would any vendor inhibit access to training on their system?